Doctor Report 2013 More and more children with ADHD?

Number of ADHD diagnoses rose again massively

29/01/2013

Attention deficit / hyperactivity disorder (ADHD) - also known as Zappelphilipp syndrome - is a common diagnosis today, but doctors have warned for years, frivolous children lightly put on the ADHD stamp. The increase in the diagnoses is downright inflationary, according to the statement of the deputy CEO of Barmer GEK, Dr. Ing. Rolf-Ulrich Schlenker, at the presentation of the „Doctor Report 2013“. Overall, the researchers from the Institute for Social Medicine, Epidemiology and Health Systems Research (ISEG) in Hanover evaluated the data of more than eight million insured persons of Barmer GEK from 2006 to 2011 for the report.

ADHD is the main topic of the Barmer GEK Physician Report 2013. On behalf of the health insurance, the Institute for Social Medicine, Epidemiology and Health System Research also has its first for the current doctor's report „some parent-related factors that influence the risk of ADHD diagnosis and the regulation of medications with methylphenidate in children“ determined, reports the health insurance company. Overall, the number of ADHD diagnoses in children and adolescents climbed until the age of 19 years „between 2006 and 2011 from 2.92 to 4.14 percent“, so the message of Barmer GEK. This corresponds to an increase of 42 percent. „Age is the proportion of the population with an ADHD diagnosis“, according to the health insurance, „even increased by 49 percent.“

ADHD diagnoses especially often to the end of primary school age
From when a child is morbidly unfocused and hyperactive remains among experts until today controversial. But in practice, doctors seem to be far more likely to get a diagnosis than a few decades ago. Although physicians have warned for a long time against a careless ADHD diagnosis, the ADHD diagnoses have increased significantly, according to Barmer GEK physician report again. The authors of the report conclude that the increased diagnosis also reflects the expectations of the parents. Conspicuous, restless, unfocused, especially active children do not seem to fit in properly with our training system. Particularly high rates of diagnosis are recorded at the end of primary school age before the transition to secondary schools, report the authors of the report, Dr. med. Thomas G. Grobe and Professor Friedrich W. Schwartz of the Institute for Social Medicine, Epidemiology and Health Systems Research. They assess the renewed increase in ADHD diagnoses extremely critically. „In Germany, more and more ADHD is diagnosed, although the public and professional awareness of this disease has been high for more than a decade, "said Prof. Schwartz.

750,000 ADHD diagnoses in 2011
According to the Barmer GEK physician report, a total of around 750,000 people were diagnosed with ADHD in 2011, with a majority of the diagnoses affecting (620,000) persons aged up to 19 years. Men were significantly more likely to have an ADHD diagnosis than women (552,000 men versus 197,000 women). However, the diagnostic rates showed significant regional differences. Thus, in the nationwide average, almost twelve percent of boys between the ages of ten and twelve received an ADHD diagnosis, while in Lower Franconia, for example, the diagnosis rate was well above average at 18.8 percent, reports Barmer GEK. Among the girls in Lower Franconia, an even clearer violation of the nationwide average was observed (around four percent in Germany, 8.8 percent in Lower Franconia). The regional differences also occurred with the drug prescriptions against ADHD, write the authors of the physician report. While about 6.5 percent of boys aged between ten and twelve years of age received a prescription in the federal average, this figure was 13.3 percent in Lower Franconia. 5.5 percent of girls in Lower Franconia received such medication compared to two percent of the national average. Apparently, the physicians in Lower Franconia tend more likely to ADHD diagnosis and a corresponding medication with methylphenidate (trade name Ritalin). Why the diagnosis rate is so clearly above the national average, however, remains open in the medical report of Barmer GEK.

20 percent of boys with ADHD
In the historical analysis of the ADHD diagnoses becomes clear that scarce „20 percent of all boys born in 2000 were diagnosed with ADHD between 2006 and 2011“ were, reports the Barmer GEK. For the girls this year, it had been 7.8 percent. According to the experts of ISEG, based on the latest data „a quarter of all men and more than 10 percent of all women“ expect an ADHD diagnosis during the life course. Similarly frightening is the development of the regulations of Ritalin (methylphenidate). These also increased significantly between the years 2006 and 2011, although in 2010 for the first time a decline in the prescribed daily doses was registered. In 2011, approximately seven percent of boys and two percent of girls aged eleven received Ritalin. According to the figures of the physician report, the drug was prescribed in 2011 about 336,000 people. „Over the course of childhood and adolescence, an estimated 10 percent of boys and 3.5 percent of girls are likely to receive methylphenidate at least once“, so the message of Barmer GEK. Which risks can be associated with this has not yet been finally clarified. Possible side effects include growth disorders in children, sleep disorders, loss of appetite and cardiac arrhythmia in the discussion.

Low educational level of parents as a risk factor for ADHD
The ISEG scientists also identified some parent-related factors in the physician's report that affect the risk of ADHD diagnosis and the regulation of medications with methylphenidate in children. They found that parents' levels of education are associated with a decreasing risk of ADHD, while a low level of education of parents is associated with an increased incidence of ADHD. Also, children of unemployed parents are more often affected and „ADHD tends to be less frequently diagnosed among children of good earners“, reports the Barmer GEK. In addition, give it „Evidence suggests that children of younger parents have a higher risk of diagnosis than those of middle-aged parents.“ According to the 2013 Physician Report, children with one parent between the ages of 20 and 24 are about 1.5 times more likely to have ADHD than children between the ages of 30 and 35 years. The CEO of Barmer GEK, Dr. Ing. Rolf-Ulrich Schlenker, do not deliver. „Whether this is due to greater serenity of parents in advanced age or to educational problems younger, remains open, "said Dr. Schlenker.

Difficult diagnosis of behavioral problems
The difficult thing about the ADHD diagnosis, according to the experts, the determination of the limit from which a pathological behavioral abnormality is present. In principle, this requires intensive discussion with the patients, for whom, however, not infrequently there is not enough time in day-to-day practice. Thus, the renowned health economist and drug researcher Gerd Glaeske of the University of Bremen told the „star“, that the first problem with ADHD diagnosis already appears here. Often there is hardly enough time for extensive examinations. Parents and teachers want to see the problem solved and rely on a quick treatment. Thus, the diagnosis is often made quickly and offer the parents supposedly simple answers to many questions. But not every troubled child suffers from ADHD and treatment with Ritalin is by no means always necessary.

Alternative ways of ADHD therapy
Depending on the severity of the disease, there are also other options for ADHD therapy, such as effective parent training or behavioral therapy, said Manfred Döpfner, an expert in child and adolescent psychiatry at the University of Cologne. „The therapeutic support of the children, but also the parents is essential for the successful treatment of ADHD“, so Döpfner opposite the „star“. However, alternative treatment offers are in short supply and the waiting lists are overcrowded. The doctors are therefore „often in an ethical dilemma: either they treat the children with Ritalin, or they do not treat them at all“, explained the expert and also demanded from the health insurance companies a greater commitment. The „therapeutic capacities for parents and children“ would have to be expanded and of course also be paid, so the conclusion of the child and adolescent psychologist. (Fp)

Also read about ADHD:
ADHD: Many adults unconsciously suffer from it
Study: ADHD is often misdiagnosed
ADHD: Physiotherapy instead of psychostimulants?
More and more children are receiving ADHD medication
Trend reversal in ADHD therapy?
ADHD: concentration through noise
Environmental factors hardly investigated in ADHD

Picture credits: Benjamin Thorn